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General NPI Number Information
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NPI Number | 1508831041
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Entity Type | Individual
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Provider Name | MATTHEW S SEGEDY MD
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Gender | Male
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Dates
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Enumeration Date | 02/20/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 17705 HUTCHINS DR
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City | MINNETONKA
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State | MN
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Zip | 55345-4145
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Country | US
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Telephone | 952-401-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 1241 CEDAR LAKE RD S
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City | MINNEAPOLIS
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State | MN
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Zip | 55416-3605
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Country | US
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Telephone | 612-377-1551
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 40142
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License Number State | MN
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